Oral Immunotherapy for Food Allergy: A Spanish Guideline. Immunotherapy Egg and Milk Spanish Guide (ITEMS Guide). Part I: Cow Milk and Egg Oral Immunotherapy: Introduction, Methodology, Rationale, Current State, Indications, Contraindications, and Oral Immunotherapy Build-up Phase.

BACKGROUND AND OBJECTIVE: Cow milk and egg are the most frequent causes of food allergy in the first years of life. Oral immunotherapy (OIT) has been investigated as an alternative to avoidance diets. No clinical practice guidelines on the management of OIT with milk and egg are currently available. Objectives: To develop clinical guidelines for OIT based on available scientific evidence and the opinions of experts. METHODS: A review was made of studies published between 1984 and June 2016, doctoral theses published in Spain, summaries of communications at scientific meetings (SEAIC, SEICAP, EAACI, and AAAAI), and the consensus of opinion established by a group of experts from the scientific societies SEICAP and SEAIC. RESULTS: Recommendations were established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of adverse reactions. CONCLUSIONS: Clinical practice guidelines based on the consensus reached between Spanish experts are presented for the management of OIT with milk and egg.

Oral immunotherapy for food allergy: A Spanish guideline. Egg and milk immunotherapy Spanish guide (ITEMS GUIDE). Part 2: Maintenance phase of cow milk (CM) and egg oral immunotherapy (OIT), special treatment dosing schedules. Models of dosing schedules of OIT with CM and EGG.

INTRODUCTION: Cow's milk and egg are the most frequent causes of food allergy in the first years of life. Treatments such as oral immunotherapy (OIT) have been investigated as an alternative to avoidance diets. No clinical practice guides on the management of OIT with milk and egg are currently available. OBJECTIVES: To develop a clinical guide on OIT based on the available scientific evidence and the opinions of experts. METHODS: A review was made of studies published in the period between 1984 and June 2016, Doctoral Theses published in Spain, and summaries of communications at congresses (SEAIC, SEICAP, EAACI, AAAAI), with evaluation of the opinion consensus established by a group of experts pertaining to the scientific societies SEICAP and SEAIC. RESULTS: Recommendations have been established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of suffering adverse reactions. CONCLUSIONS: A clinical practice guide is presented for the management of OIT with milk and egg, based on the opinion consensus of Spanish experts.

Oral immunotherapy for food allergy: A Spanish guideline. Immunotherapy egg and milk Spanish guide (items guide). Part I: Cow milk and egg oral immunotherapy: Introduction, methodology, rationale, current state, indications contraindications and oral immunotherapy build-up phase.

INTRODUCTION: Cow's milk and egg are the most frequent causes of food allergy in the first years of life. Treatments such as oral immunotherapy (OIT) have been investigated as an alternative to avoidance diets. No clinical practice guides on the management of OIT with milk and egg are currently available. OBJECTIVES: To develop a clinical guide on OIT based on the available scientific evidence and the opinions of experts. METHODS: A review was made of studies published in the period between 1984 and June 2016, Doctoral Theses published in Spain, and summaries of communications at congresses (SEAIC, SEICAP, EAACI, AAAAI), with evaluation of the opinion consensus established by a group of experts pertaining to the scientific societies SEICAP and SEAIC. RESULTS: Recommendations have been established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of suffering adverse reactions. CONCLUSIONS: A clinical practice guide is presented for the management of OIT with milk and egg, based on the opinion consensus of Spanish experts.

Oral Immunotherapy for Food Allergy: A Spanish Guideline. Egg and Milk Immunotherapy Spanish Guide (ITEMS GUIDE). Part II: Maintenance Phase of Cow Milk (CM) and Egg Oral Immunotherapy (OIT), Special Treatment Dosing Schedules. Models of Dosing Schedules of OIT With CM and Egg.

BACKGROUND AND OBJECTIVE: Cow milk and egg are the most frequent causes of food allergy in the first years of life. Oral immunotherapy (OIT) has been investigated as an alternative to avoidance diets. No clinical practice guidelines on the management of OIT with milk and egg are currently available. Objectives: To develop clinical guidelines for OIT based on available scientific evidence and the opinions of experts. METHODS: A review was made of studies published between 1984 and June 2016, doctoral theses published in Spain, summaries of communications at scientific meetings (SEAIC, SEICAP, EAACI, and AAAAI), and the consensus of opinion established by a group of experts from the scientific societies SEICAP and SEAIC. RESULTS: Recommendations were established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of adverse reactions. CONCLUSIONS: Clinical practice guidelines based on the consensus reached between Spanish experts are presented for the management of OIT with milk and egg.

Modelo de eficiencia de los fármacos biológicos en el tratamiento de la psoriasis moderada-grave durante un año en las condiciones de uso en España / Model for assessing the efficiency of biologic drugs in the treatment of moderate to severe psoriasis for one year in clinical practice in Spain

INTRODUCCIÓN: La mayoría de las evaluaciones económicas publicadas sobre terapias biológicas en el tratamiento de la psoriasis no reflejan la práctica clínica habitual ni incorporan el coste asociado al manejo de los pacientes. OBJETIVO: El objetivo del presente estudio es establecer un modelo de la eficiencia de los fármacos biológicos en el tratamiento de la psoriasis, incorporando el coste asociado al manejo de los pacientes en función de la respuesta que se hace en la práctica clínica habitual. MÉTODOS: Se ha desarrollado un modelo de árbol de decisión que incorpora la probabilidad de respuesta y fracaso de adalimumab, etanercept, infliximab y ustekinumab tras 24 semanas de tratamiento (final de la fase de inducción) obtenida a partir de un metaanálisis. Se han considerado costes sanitarios directos: farmacológicos y de administración (euros, 2015). Este análisis se ha llevado a cabo desde la perspectiva del hospital, considerando un horizonte temporal de un año. RESULTADOS: Según el modelo propuesto, el coste medio anual por estrategia de tratamiento de inicio más bajo corresponde a aquellos pacientes que inician tratamiento con ustekinumab, aunque las diferencias porcentuales con infliximab y adalimumab no llegan al 3%. Considerando un presupuesto fijo de 1.000.000€, la estrategia de inicio que permite tratar con éxito a mayor número de pacientes durante un año según este modelo sería ustekinumab (66), seguido de infliximab (62), adalimumab (59) y etanercept (50). Los análisis de sensibilidad confirman la consistencia de estos resultados, aunque, teniendo en cuenta los intervalos de confianza de la eficacia incremental observada en el metaanálisis, las diferencias encontradas probablemente no sean significativas en todas las posibles comparaciones binarias, y las posibles modificaciones en la estructura real de precios, en las características de la población o en las estrategias y objetivos terapéuticos en cada centro pueden dar lugar a variaciones importantes en la vida real. CONCLUSIONES: El coste del manejo de los pacientes que no alcanzan una respuesta adecuada durante la fase de inducción no debe ser ignorado, puesto que es determinante a la hora de establecer la eficiencia del tratamiento. La información que proporciona este análisis debe contrastarse con los datos reales de la práctica clínica española en cada contexto geográfico y hospitalario para optimizar la asignación de recursos y tratar a un mayor número de pacientes de manera eficiente

INTRODUCTION: Most economic evaluations in the literature on the subject of biologic therapy for the treatment of psoriasis do not reflect normal clinical practice or consider the cost of patient management. OBJECTIVE: The objective of the present study is to establish a model for assessing the efficiency of biologic therapies in the treatment of psoriasis taking into account the cost of managing treatment which, in routine clinical practice, depends on patient response. METHODS: We developed a model based on a decision tree that incorporates the probability of treatment response or failure with adalimumab, etanercept, infliximab, and ustekinumab after 24 weeks of therapy (end of the induction phase). The probability in each case was calculated using data from a meta-analysis. The following direct health costs were taken into account: the cost of drugs and their administration in euro (2015). Our analysis was based on the cost of 12 months of treatment administered in a hospital setting. RESULTS: According to the proposed model, the mean cost per year by initial treatment strategy was lowest for patients who started treatment with ustekinumab, although the percentage cost difference between ustekinumab and infliximab or adalimumab was less than 3%. With a fixed budget of €1,000,000, the initial treatment option that would achieve success in the largest number of patients for one year would, according to this model, be ustekinumab (66 patients), followed by infliximab (n = 62), adalimumab (n = 59), and etanercept (n = 50). Sensitivity analysis confirmed the reliability of these results. However, considering the confidence intervals of the incremental efficacy observed in the meta-analysis, the differences found are probably not significant in all the possible binary comparisons. Likewise, possible differences in actual price structures, populations, and the strategies and therapeutic objectives of each hospital could all give rise to considerable variations in real life. CONCLUSIONS: The cost of managing treatment in patients who fail to achieve an acceptable response during the induction phase should also be considered since such costs are a determining factor in any assessment of treatment efficiency. To achieve the optimum allocation of resources and to treat more patients efficiently, the information provided by this analysis should be cross-checked with real data taken from actual clinical practice in Spain collected in each geographical region and hospital

Model for assessing the efficiency of biologic drugs in the treatment of moderate to severe psoriasis for one year in clinical practice in Spain.

INTRODUCTION: Most economic evaluations in the literature on the subject of biologic therapy for the treatment of psoriasis do not reflect normal clinical practice or consider the cost of patient management. OBJECTIVE: The objective of the present study is to establish a model for assessing the efficiency of biologic therapies in the treatment of psoriasis taking into account the cost of managing treatment which, in routine clinical practice, depends on patient response. METHODS: We developed a model based on a decision tree that incorporates the probability of treatment response or failure with adalimumab, etanercept, infliximab, and ustekinumab after 24 weeks of therapy (end of the induction phase). The probability in each case was calculated using data from a meta-analysis. The following direct health costs were taken into account: the cost of drugs and their administration in euro (2015). Our analysis was based on the cost of 12 months of treatment administered in a hospital setting. RESULTS: According to the proposed model, the mean cost per year by initial treatment strategy was lowest for patients who started treatment with ustekinumab, although the percentage cost difference between ustekinumab and infliximab or adalimumab was less than 3%. With a fixed budget of €1,000,000, the initial treatment option that would achieve success in the largest number of patients for one year would, according to this model, be ustekinumab (66 patients), followed by infliximab (n = 62), adalimumab (n = 59), and etanercept (n = 50). Sensitivity analysis confirmed the reliability of these results. However, considering the confidence intervals of the incremental efficacy observed in the meta-analysis, the differences found are probably not significant in all the possible binary comparisons. Likewise, possible differences in actual price structures, populations, and the strategies and therapeutic objectives of each hospital could all give rise to considerable variations in real life. CONCLUSIONS: The cost of managing treatment in patients who fail to achieve an acceptable response during the induction phase should also be considered since such costs are a determining factor in any assessment of treatment efficiency. To achieve the optimum allocation of resources and to treat more patients efficiently, the information provided by this analysis should be cross-checked with real data taken from actual clinical practice in Spain collected in each geographical region and hospital.

[Relationship between previous severity of illness and outcome of in-hospital cardiac arrest]. / Relación entre el estado de gravedad previo y el pronóstico de la parada cardiaca intrahospitalaria.

OBJECTIVES: To analyze the relationship between previous severity of illness, lactic acid, creatinine and inotropic index with mortality of in-hospital cardiac arrest (CA) in children, and the value of a prognostic index designed for adults. METHODS: The study included total of 44 children aged from 1 month to 18 years old who suffered a cardiac arrest while in hospital. The relationship between previous severity of illness scores (PRIMS and PELOD), lactic acid, creatinine, treatment with vasoactive drugs, inotropic index with return of spontaneous circulation and survival at hospital discharge was analyzed. RESULTS: The large majority (90.3%) of patients had a return of spontaneous circulation, and 59% survived at hospital discharge. More than two-thirds (68.2%) were treated with inotropic drugs at the time of the CA. The patients who died had a higher lactic acid before the CA (3.4 mmol/L) than survivors (1.4 mmol/L), P=.04. There were no significant differences in PRIMS, PELOD, creatinine, inotropic drugs, and inotropic index before CA between patients who died and survivors. CONCLUSION: A high lactic acid previous to cardiac arrest could be a prognostic factor of in-hospital cardiac arrest in children.

Severe Raynaud syndrome induced by adjuvant interferon alfa in metastatic melanoma.

Melanoma is the most lethal form of skin malignancy because of its aggressive behaviour. In advanced disease, interferon alfa can be used as adjuvant therapy. However, this therapy is not free of side effects. We present a case of severe Raynaud syndrome and digital necrosis induced by interferon alfa in a patient with melanoma. Pathogenic mechanisms are discussed.

Nevus azul con área central despigmentada / Blue naevus with central depigmented area

El nevus azul es una lesión benigna papular o nodular con coloración que varía desde el azul-oscuro al azulnegruzco. Las localizaciones más comunes son el dorso de las manos y pies, brazos, piernas, cara y cuero cabelludo. Se presenta el caso de una mujer de 60 años con una lesión sobreelevada en el cuero cabelludo de más de 30 años de evolución, en cuyo centro apareció un área central despigmentada. Tras la toma de biopsia y posterior extirpación completa de la lesión, fue diagnosticada de nevus azul celular. La aparición de dicha área central despigmentada posiblemente está relacionada con un traumatismo continuado y repetitivo por la acción del cepillado del pelo. (AU)

[Postabortion contraception]. / Anticoncepción postaborto.

In Mexico, as in almost all the Latin American countries, abortion represents an important maternal morbidity-mortality reason. It has been pointed out that those women who had an abortion, are in greater risk to repeat this condition than those women who have not had the episode. For this reason, it is a transcendental matter, the use of modern contraceptive technology for fertility regulation with the aim to avoid not planned pregnancies and their devastating consequences. This document reviews-according to the Family Planning Official Norm of the Ministry of Health-those different contractive alternatives, that can be used in the postabortion.

[Skin aging and smoking]. / Envejecimiento cutáneo y tabaquismo.

Facial wrinkling is a marker of skin ageing. The association between smoking and facial wrinkling has been previously studied. Nevertheless, there are no reports assessing the role of sun exposure and smoking in an area with a great proportion of sunny days. Smoking habits were investigated in 282 healthy individuals. Facial wrinkles were measured according to the Daniell scale at the external canthus. A logistic regression model was developed controlling for age, sex, sun exposure, smoking habit and searching for the interaction between sun exposure and smoking. A statistically significant risk was found for smoking habit (OR = 3.1; 95% CL 1.28-7.76; p = 0.008), sun exposure (OR = 1.50; 95% Cl 1.25-1.80; p = 0.05), and age (OR = 1.18; 95% Cl 1.13-1.23; p = 0.024) for facial wrinkling. These results show the evidence of an accelerated skin ageing in smokers. A clear explanation given to smokers could be a useful strategy to persuade them to leave smoking.

[Melanoma-lymphoma association]. / Associazione melanoma-linfoma.

The association of malignant melanoma with different neoplasias is uncommon but not exceptional. We present two cases of malignant melanoma associated with lymphoma, and analyze the variety of etiopathogenic factors which have been implicated in both neoplasias, with special emphasis on those that may explain this association.

[Dermatosis with the phenomenon of transepidermal elimination]. / Dermatosis con fenómeno de eliminación transepidérmica.

A revision was carried out on all cases of dermatosis involving transepidermal elimination seen in the last 25 years in the Department of Medical Surgical Dermatology and Venereology, School of Medicine, University of Granada. The study included clinical-statistical, therapeutic, histopathologic and evolutional aspects. In the discussion the low incidence of perforating dermatoses in the Eastern Andalusian area is emphasized.

[23 observations of subungual exostosis]. / Veintitrés observaciones de exostosis subungueal.

Twenty-three cases of subungual exostosis are described, representing an incidence of 0.031% in our setting. Children and adolescents were most frequently affected, with a clear predominance of females. Eight lesions were observed in exceptional locations, three on the fingers and five on the third and fourth toes. The results of the surgical technique employed to excise the exostosis are evaluated.

[Infantile acro-localized papulo-vesicular syndromes]. / Síndromes pápulo-vesiculosos acrolocalizados infantiles.

Seven observations of papulo-vesicular acrolocated syndromes in males between 6 months and three years age. Clinical, histological and nosological aspects are commented in according to Gianotti's words and last reports about this disease.